New Client Paperwork
Please print and complete the relevant paperwork below to bring to your first appointment. Please fill out as much as you can, and your therapist will work with you to address any questions or concerns you may have. If you are unable to bring your paperwork with you, please arrive 20-30 minutes prior to your appointment, and we will be happy to provide copies for your to fill out in our office.
Adult Intake Packet (18 and over)
Child/Adolescent Intake Packet (under 18)
For couples counseling, please complete two sets of adult paperwork.
For family counseling , please complete paperwork for each family member participating.
(to be completed by a healthcare provider)
In order to ensure a safe and supportive transfer of services for your client, we request referral sources complete the External Referral Form for Outpatient Services. Our Intake Team will contact the client directly and inquire as to any accommodations they may need, inform them of fees, and schedule them with an appropriate clinician. If you would like to discuss your referral with a member of our Intake Team, they can be reached at (614) 849-8204.
Please submit the completed form via email to [email protected] or fax to (844) 272-9333
Notice of Privacy Practices
To view Nemeth Counseling's Notice of Privacy Practices, please click on the link below: